Association of alcohol intake with pre-sarcopenia risk in steatotic liver disease: a dose-dependent relationship

Objectives An increased gradient of alcohol intake distinguished distinct clinical outcome risks across steatotic liver disease (SLD) subcategories, including metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol liver disease (ALD). However, association between alcohol intake and pre-sarcopenia risk was not studied. Methods All adult participants with complete data of alcohol intake, controlled transient elastography and dual-energy X-ray absorptiometry were collected from the National Health and Nutrition Examination Survey 2017–2018. The pre-sarcopenia burden was compared between SLD and non-SLD, also across SLD subcategories. Association between alcohol intake and pre-sarcopenia risk was evaluated by logistic regression and restricted cubic spline analysis. Results Among 1506 evaluable participants, there were 836 non-SLD participants, 354 MASLD, 185 MetALD, 115 ALD and 16 cryptogenic SLD participants. The prevalence of pre-sarcopenia in SLD was higher than that in non-SLD (14.93% vs. 5.02%). Regardless of sex, three SLD subcategories had the lower appendicular lean mass index than non-SLD group. The pre-sarcopenia prevalence was only higher among males in SLD subcategories than non-SLD group. An L-shaped negative nonlinear relationship between alcohol intake and pre-sarcopenia was observed in females (0–28 g/day), but not in males. Logistic regression showed physical inactivity, lower creatinine, higher weight-adjusted waist index and sex male were associated with increased pre-sarcopenia risk. Conclusion Regardless of sex, MASLD, MetALD or ALD had a higher pre-sarcopenia burden than non-SLD. A nonlinear relationship between low-moderate alcohol intake and pre-sarcopenia risk was revealed in females.